Speaking up behavior and cognitive bias in hand hygiene: Competences of German-speaking medical students

Abstract

Introduction Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine. Methods On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach's Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick. Results 1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p<0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164

Self-Assessment and Learning Motivation in the Second Victim Phenomenon

“…Next, we could show that in the absence of “horizontal” clinical tribalism (among the professions [ 21 ]), it might be possible that there is a kind of “vertical” clinical tribalism towards students and supervisors. While students may be found easy to be cared for, our data showed that responders seem to not speak up on supervisors in case of witnessing SVP symptoms in them–likely based on hierarchical issues and perhaps anxiety about being blamed for an insulting intervention and fear for stigmatisation or loss of authority [ 22 , 38 , 39 ]. Especially for leaders, it might be relevant that if they face SVP or even develop psychic pathologies, this may affect the safety of patients, staff and the institution’s reputation and economy [ 2 ].…”

“…A further effect is the clinical tribalism phenomenon (CTP) belonging to the in-group biases [ 21 ]: comparable to the over-placement-effect: persons estimate their own occupational group to be better than other groups. We were able to demonstrate this related effect for several infection control and communication skills in 2021, summarised in [ 22 ]. Further, our working group generated a hypothesis framework shown in Figure 1 for a better understanding of the different models and their assumed interactions.…”

Teaching health care students hand hygiene theory and skills: a systematic review

“…Even where whole cohorts were invited to participate, it may be that only those who were motivated to learn participated; it is impossible to know about the relevant motivations of those who did, and did not participate. Heavy reliance was placed on the use of self-reported scales to document practice although student report is a poor indicator of students' hand hygiene performance: over-confidence and tendency to inflate adherence are both well-established (Cole 2009;Bushuven et al 2020). A scale to assess student health workers' knowledge and attitudes to hand hygiene has been developed (Van De Mortel 2009) and validated (Karadag et al 2016) but was adopted by only two research teams and of these, one reported that students encountered difficulties with completion.…”

“…Patient safety concerns are common, one study suggesting that 62% of doctors and 80% of nurses reported at least one safety concern in the last four weeks (Schwappach and Richard 2018). However, speaking-up in case of poor hand hygiene may be rare, particularly if there is a hierarchical imbalance (Bushuven et al 2020). The negative impact of hierarchies on voicing safety concerns has been noted more broadly, along with the expected behaviours and socialisation of nurses within the care team (Morrow et al 2016).…”

“…Even when adequate theoretical knowledge is displayed, students seem unable or unwilling to implement learning into clinical practice (Zimmerman et al 2020). Heavy workload, poor access to alcohol-based handrubs and sinks, lack of effective role models and perceived need to model practice according to local custom, including a reticence to challenge those in more senior positions, and overconfidence in ones own ability have all been suggested as factors reducing students' adherence to hand hygiene protocols (Barrett and Randle 2008;Cresswell and Monrouxe 2018;Bushuven et al 2020;Zimmerman et al 2020).…”